Back pain affects nearly 80% of Americans and the most common form is Low Back Pain. Because you rely on your back for almost every move you make, it is vulnerable to injury. Back pain can even be disabling. It is one of the most common problems prompting a visit to your doctor and for missing work. In fact, it is the second highest cause of disability in persons under the age of 45.
Although people complain of back pain, it is not a diagnosis but rather a symptom of an underlying disorder. There are two types of back pain, acute and chronic. Acute back pain is pain with a new onset. It comes on suddenly, usually due to injury. This is the most common type of back pain. It is usually resolved in less than one month but no more than 6 weeks duration. Chronic pain is pain that can have a quick or slow onset, but it lingers for long periods of time. Although it may last three months or longer, some people experience a lifetime of chronic back pain. Chronic pain is the least common type of pain.
What Causes Back Pain?
To begin to understand the causes of back pain, we need to understand the spine. The back is made up of 33 vertebrae or bones. It is divided into 5 groups: Cervical, Thoracic, Lumbar, Sacrum and Coccyx. The cervical spine (upper back or neck) consists of 7 vertebrae. The thoracic(middle back) has 12, and the lumbar spine(low back) has 5 vertebrae. The sacrum consists of 5 fused vertebrae, and the coccyx(tail bone) has 4 vertebrae fused together.
The vertebrae are held together by ligaments and muscles with discs between the vertebrae. The discs are filled with a jellylike center, allowing them to act like a shock absorber. The vertebrae link together to provide stability and support. They protect the spinal cord and spinal nerves that run through the spinal canal.
Because the neurological system is complex, it is difficult to pinpoint the exact cause of back pain. The causes of back pain are divided into categories: Mechanical, Injuries, Acquired disorders or diseases, Infections or tumors.
Mechanical causes: These are problems with how the spine works. For example, Spondylolistesis(deterioration of the disc one vertebrae to slip forward over another, causing the vertebrae to rub together, therefore causing pain). Other mechanical problems are fractures, herniated discs, spinal stenosis, spinal degeneration and sciatica.
Injuries- This category includes common forms of back pain due to injury to the spine or the ligaments and muscles involved with the spine. Sprains, for example, result if a ligament that supports the spine is pulled or torn due to improper lifting or body mechanics, even twisting the wrong way, Fractures can occur from osteoarthritis which causes the bones to become brittle and weak. Sever injuries can result from an accident or fall.
Acquired disorders- These are medical problems that you might have been born with such as scoliosis(an abnormal curvature of the spine) to other problems that you acquired, such as arthritis(osteoarthritis and rheumatoid arthritis) which can lead to fractures; musculoskeletal pain syndromes such as fibromyalgia, spinal stenosis (Narrowing of the spinal canal putting pressure on spine or nerves); and even pregnancy.
Infection/Tumors- Infection, although not common, can cause pain if it involves the vertebrae. Two examples of this are Osteomyelitis(infection and inflammation of the vertebrae) and Discitis(infection in the discs).Tumors, although rare, can also cause back pain. These can be benign or cancerous, but usually result from a tumor that has spread from another area of the body.
How is back pain diagnosed?
In order for your physician to discuss the proper treatment for your back pain, he will need to do a thorough medical history and physical exam. You will need to give a clear concise description of your pain. Your physician will need to know how the pain started, what you were doing when it started, how severe it is, does it come and go or is it constant, and what makes the pain better or worse. You will need to undergo some diagnostic tests. Common tests done to diagnose back pain are x-rays, bone scans, and MRI’s. These diagnose problems due to bone or soft tissue injuries. Your doctor may order blood and urine tests to look for infection. If your physician feels the pain might be caused by a nerve problem, then you will have an EMG(electromyography) or nerve study. An EMG is an assessment of the electrical impulses of nerves and the response of the muscles.
How is Back Pain Treated?
The common goals of treatment are to relieve back pain and to restore mobility. Treatment varies depending on the severity and type of injury. The most common and basic treatment used for strains or minor injury is Rest. Heat can be used to promote circulation to the area and relieve spasms. Cold packs can be used to decrease the swelling in the affected area of the back. Common OTC (over the counter) medications such as Aspirin, Motrin, Tylenol, and Aleve are prescribed to help the pain and inflammation.
Long term bed rest is not usually recommended because it can make recovery slower and can ultimately cause other problems. Usually the doctor will have you gradually resume normal activities after 24-72 hours of rest. He may start you on a physical therapy program which should include heat, massage, ultrasound and an individualized exercise regimen. If the pain does not subside and it is interfering with your normal daily activities, your doctor may order prescription pain medications such as Darvocet, Vicodin, or Percocet and anti-inflammatory agents to relieve muscle spasm.
If your pain becomes chronic and all other treatments have failed, your doctor may refer you to a Back or Pain specialist. Because the back is a complex entity, specialists are more up to date on new advances in the treatment of back pain. Some treatments you might encounter are epidural nerve block (injection of anesthetic, anti-inflammatory, or steroid into the epidural space of the back for long term pain relief)and trigger point injections(injection of steroids and anesthetic into the muscle that is triggering pain.)This should also provide long term pain relief. Other medications such as antidepressants and anticonvulsants have been found to help relieve pain caused by nerve injuries.
Other types of treatment include:
Use of TENS(transcutaneous electrical nerve stimulation) unit. Electrodes are placed on 2-3 painful areas of the back and attached to a unit that provides mild electrical stimulus to the area in order to relieve pain.
Chiropractic adjustments of the back.
Acupressure or acupuncture treatments.
Relaxation and breathing techniques and stress management instruction.
Massage and basic stretching exercises to promote mobility and relieve spasm.
Yoga-and Pilates- This can help relieve pain and stress. Some Yoga postures may help relieve low back pain and help improve strength, flexibility and balance. Yoga is good for stress reduction and can help with the psychological aspects of pain.
Aquatic or water therapy- This can be very beneficial in relieving pain and improving mobility in those with chronic low back pain. There is no resistance to movement in the water, and water is soothing, comforting, and relaxing for the body.
How can Back Pain be Prevented?
Although some people say that you can’t avoid injuring your back, most doctors are in agreement that the common causes of back pain can be prevented by following a few lifestyle changes:
- Exercise: You will need to consult your physician prior to starting an exercise program because there are some exercises, such as high impact aerobics and weight lifting that can make back pain worse. Other exercise, such as swimming, walking and biking can help overall health and strengthen the back. Nonetheless, exercise should not be avoided as it helps to improve overall health.
- Lumbar support belts: Some people that work jobs that do heavy lifting on a daily basis are required to wear lumbar support and undergo back training on the job to learn how to prevent lifting injuries.
- Do not wear high heels.
- Keep head up and stomach in when standing. If standing for prolonged periods of time, place one foot up on a stool and alternate your weight frequently.
- Sit in a chair with good lumbar support. Maintain good posture, sit up straight and keep both feet flat on the floor. Make a lumbar roll out of a rolled towel to place behind the low back when you drive or sit for prolonged periods of time.
- Use proper body posture when lifting. Keep objects close to your body. Keep your back straight and your head up with stomach tucked in. Don’t lift objects that are too heavy. Get help when lifting awkward or heavy objects. Don’t bend forward to pick something up, rather bend at the knees and lift straight up from the knees.
In conclusion, back pain can be difficult to treat but there are many options out there for you. Specialists are finding new research every day. You can take care of your back by making good lifestyle changes and eliminating or reducing the amount of stress in your life. By maintaining good posture, using proper lifting techniques, and educating yourself on how to avoid back pain, you can prevent more back injury.